Новокузнецкий государственный институт усовершенствования врачей-филиал федерального государственного бюджетного образовательного учреждения дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения РФ, г. Новокузнецк, Россия Zorina V.N. et al. Зорина В.Н. и др. Medical Immunology (Russia)/Meditsinskaya Immunologiya Медицинская Иммунология поликистозных яичников снижена концентрация TNFα в фолликулярной жидкости и крови на фоне повышенного содержания IFNγ. При аденомиозе повышен уровень IFNγ в фолликулярной жидкости при сниженном содержании регуляторно-транспортного α2-макроглобулина в крови. Выявленные изменения концентраций цитокинов и регулирующих их синтез белков у бесплодных женщин обосновывают неэффективность программ ЭКО в ряде случаев-данный дисбаланс оказывает негативное влияние на развитие ооцитов, формирование и развитие эмбрионов, а также на их способность к имплантации. Необходимо углубленное изучение подобных факторов патогенеза для совершенствования подходов к предгравидарной подготовке, повышающих эффективность лечения хронического бесплодия методом ЭКО.
Pathogenetic mechanisms of uterine leiomyoma, adenomyosis and their combination are complicated and poorly understood, a differential diagnosis of leiomyosarcoma of the uterus is difficult. Our study aimed for a comparative analysis of the serum contents of α2-MG, PAG, some cytokines, sex steroids and the expression of steroid receptor genes in the patients with different variants of uterine proliferative diseases, in order to determine their pathological role, diagnostic and prognostic value. Expression of estrogen receptor genes adenomyosis nodes was 1.5 to 2-fold higher than in leiomyoma, the combined pathology showed intermediate values, and expression of ER and PGR genes in leiomyosarcoma was minimal. In cellular leiomyoma, expression of ER receptor genes in the surrounding myometrium was 2 to 3-fold higher than in cases of simple leiomyomas. At the same time, concentration of estrogen and progesterone in the blood is comparable between the groups and control groups. All the patients have a deficiency of immunomodulatory α2-MG (12-13% for leiomyomas, 20% for adenomyosis, and 23% for malignant pathology). The concentration of immunosuppressive PAG is increased in combined conditions and leiomyosarcoma. In addition, the contents of IL-6 and TNFα increase, the VEGF levels exceed normal values 4 to 4.5-fold, in leiomyoma, 5.5-fold, in combined pathology, 6.5, in adenomyosis, and 10-fold, in leiomyosarcoma.The obtained results confirm that immunomodulatory proteins, cytokines and cell-targeting sex hormones exert an interdependent influence upon each other in the studied diseases, and their significant changes may be used in diagnostics and prognosis.
Background. External genital endometriosis (EGE) is often the cause of infertility, while coagulation of its foci leads to the restoration of fertility. Often, non-invasivepreoperative diagnosis of EGE is difficult. Today, the issue of laparoscopy in infertility and whether there is a need for additional indications for its implementation remains controversial. Identification of the relationship between certain extragenital diseases with EGE is promising in terms of both understanding the pathogenesis of EGE and predicting its development.The aim. Identification of the relationship of extragenital diseases with the presence of EGE in infertile women of reproductive age.Materials and methods. In preparation for assisted reproductive technology programs at the Vitromed Clinic, 1 132 women of reproductive age were examined from 2019 to 2021. Collection and processing of clinical and anamnestic data were carried out. The diagnosis of EGE was verified by laparoscopy with histological examination. The results were analyzed using exact test and binary logistic regression to build a model of the relationship between EGE and somatic pathology.Results. EGE was detected in 222 patients. A number of somatic diseases were found that are most common in EGE: bowel diseases; minor cardiac maldevelopments; chronic anemia; pathology of the pancreas; chronic tonsillitis; allergy. A logistic regression model was constructed to predict the presence of EGE in patients with the indicated somatic pathology with a sensitivity of 81.53 % and a specificity of 97.25 %.Conclusion. Identification of comorbid extragenital diseases associated with EGE in women with infertility can serve as a basis for expanding the scope of therapeutic and diagnostic measures, in particular for laparoscopy.
1 Новокузнецкий государственный институт усовершенствования врачей -филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России (НГИУВ -филиал ФГБОУ ДПО РМАНПО Минздрава России), Новокузнецк, Россия, 654005; 2 Группа компаний «Мать и дитя», клиника женского здоровья и репродукции человека «МЕДИКА», Новокузнецк, Россия, 654041Цель исследования -оценить прогностическую значимость содержания иммунорегуляторных белков и цитокинов во внутриматочных смывах при бесплодии трубного генеза, ассоциированного с хроническим эндометритом (ХЭ) у женщин, участвующих в программах экстракорпорального оплодотворения. Материал и методы. Обследованы 38 женщин с ХЭ, разделенных по исходу программ ЭКО на подгруппы: у 17 наступила беременность, у 21 -нет; 26 женщин с трубным фактором бесплодия без ХЭ (у 13 наступила беременность, у 13 -нет); контрольную группу составили 10 здоровых фертильных женщин. Исследованы маточные смывы перед вступлением в программу на содержание α 2 -макроглобулина (α 2 -МГ), иммуноглобулина G (IgG), лактоферрина (ЛФ) и цитокиновинтерлейкинов (ИЛ)-6, -8, фактора некроза опухоли-α (ФНО-α), интерферона-γ (ИФН-γ), эндотелиального фактора роста (VEGF), методом иммуноферментного анализа, альбумина -методом ракетного иммуноэлектрофореза. Результаты. При ХЭ во внутриматочных смывах повышены концентрации α 2 -МГ (в 5,5 раза) и альбумина (в 3 раза) по сравнению с контролем, повышено содержание VEGF, снижен уровень ЛФ (в 2 раза), а при трубном факторе бесплодия без ХЭ уровень α 2 -МГ повышен в 2,5 раза, уровень ЛФ снижен в 2,5 раза. Наибольшие концентрации α 2 -МГ, альбумина, ФНО-α и IgG в смывах наблюдались при отрицательном исходе ЭКО у женщин с ХЭ. При трубном факторе бесплодия без ХЭ повышено содержание ФНО-α, снижено содержание ИЛ-8 только при отрицательном исходе ЭКО. Выводы. ХЭ приводит к изменению белкового состава внутриматочного содержимого, выраженные изменения ассоциированы с неблагоприятным прогнозом программ ЭКО. Содержание во внутриматочных смывах α 2 -МГ более 3,2 мг/л и альбумина более 0,24 г/л до вступления в программу ЭКО рекомендуется в качестве прогностического критерия низкой эффективности программы.Ключевые слова: хронический эндометрит, бесплодие, ЭКО, цитокины, α 2 -макроглобулин, альбумин.Objective -the evaluation of prognostic significance of the contents of immunoregulatory proteins and cytokines in endometrial lavage at infertility (tubal factor) associated with chronic endometritis (CE) in women participating in in vitro fertilization programs. Material and methods. Groups 38 women with chronic endometritis, divided by the outcome of IVF programs into subgroups: 17 became pregnant, 21 -did not; 26 women with tubal factor of infertility without CE (13 became pregnant, 13 -did not); control group of healthy fertile 10 women. The uterine lavages were collected before undergoing the program and analyzed for the maintenance of α 2 -macroglobulin (α 2 -MG), IgG, lactoferrin (LF) and cytokines (IL-6, IL-8, TNF-α, IFN-γ, VEGF) by ELISA, albumin -by r...
Purpose of the study. To assess the influence of main clinical risk factors on the effectiveness of the in vitro fertilization (IVF) program.Materials and methods. The study included 3,969 IVF programs conducted in the “Medica” clinic of the “Mother and Child” group of companies in Novokuznetsk for 2010–2015. The inclusion criterion was the availability of information on the results of the procedure conducted.Results.The structure of the considered risk factors was identified, their key features were identified: the majority of women who underwent IVF procedure were under the age of 34, inclusive, more than half of all procedures were performed at the first attempt. The main causes of female infertility were: tubal factor, including those associated with chronic endometritis, polycystic ovary syndrome, external genital endometriosis and adenomyosis. In a number of cases, as a concomitant gynecological disease, uterine fibroids have been extirpated, which is not the main cause of infertility, but the presence of which can influence the effectiveness of IVF programs. Statistically significantly more often, fibroids were found in adenomyosis and tubal factors associated with chronic endometritis. A quantitative assessment of the degree of influence of the considered risk factors on the effectiveness of IVF programs was considered, and the influence of both individual factors and their combination was considered.Conclusion.The main factors statistically significantly increasing the risk of a negative outcome of the program are: the age of a woman over 30; repeated attempt at the age of up to 30 years inclusive (in comparison with the first attempt); tubular factor associated with chronic endometritis; presence of uterine fibroids in the tubular factor associated with chronic endometritis; The presence of fibroids in the tubular factor, complicated by adenomyosis.
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